Abstract
BackgroundThe effect of peripheral nerve blocks on postoperative delirium in older patients has not been studied. Peripheral nerve blocks may reduce the incidence of postoperative opioid use and its side effects such as delirium via opioid-sparing effect.MethodsA prospective cohort study was conducted in patients who underwent total knee replacement. Baseline cognitive function was assessed using the Telephone Interview for Cognitive Status. Postoperative delirium was measured using the Confusion Assessment Method postoperatively. Incidence of postoperative delirium was compared in two postoperative management groups: femoral nerve block ± patient-controlled analgesia and patient-controlled analgesia only. In addition, pain levels (using numeric rating scales) and opioid use were compared in two groups.Results85 patients were studied. The overall incidence of postoperative delirium either on postoperative day one or day two was 48.1%. Incidence of postoperative delirium in the femoral nerve block group was lower than patient controlled analgesia only group (25% vs. 61%, P = 0.002). However, there was no significant difference between the groups with respect to postoperative pain level or the amount of intravenous opioid use.ConclusionsFemoral nerve block reduces the incidence of postoperative delirium. These results suggest that a larger randomized control trial is necessary to confirm these preliminary findings.
Highlights
The effect of peripheral nerve blocks on postoperative delirium in older patients has not been studied
Initially, we analyzed the group of patients who underwent total knee replacement (TKR) between 2001-2006
We found that there was a trend of lower incidence of postoperative delirium in the femoral nerve block group (33% vs. 58%, P = 0.06) with no differences in postoperative pain and opioid consumption
Summary
The effect of peripheral nerve blocks on postoperative delirium in older patients has not been studied. Peripheral nerve blocks may reduce the incidence of postoperative opioid use and its side effects such as delirium via opioid-sparing effect. Postoperative delirium is a common postoperative complication among older surgical patients, occurring in up to 60% of surgical patients after major surgery [1]. Postoperative delirium is associated with increased mortality and morbidity, greater medical expenses, prolonged hospital stays and poor functional status [2,3]. Previous work from our laboratory and the work from others suggest that postoperative pain is an important factor related to postoperative delirium [5,8]. The effects of postoperative pain management technique, especially the effects of peripheral nerve blocks on postoperative delirium, have not been investigated.
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